Epididymitis is inflammation of the epididymis, the coiled tube in the testicle where sperm mature. When the condition is acute, epididymitis symptoms—which can appear unexpectedly—last less than six weeks and consist of pain, swelling, and inflammation of the epididymis. If both the epididymis and testicles become inflamed, the acute condition is then referred to as epididymo-orchitis.
Men with gradual testicular, epididymal, or scrotal pain lasting longer than six weeks are diagnosed as having chronic epididymitis—even if the pain waxes and wanes or is mild. Untreated, this condition can lead to scrotal abscess (infected tissue packed with pus), testicle shrinkage, male infertility, and tissue death (necrosis).
While it can occur at any age, epididymitis is most common in men between the ages of 14 and 35. It is nearly always due to an infection of some sort, whether sexually transmitted or otherwise. Two-thirds of all new (acute) cases can be attributed to chlamydia, with gonorrhea and E. coli responsible for the rest. Mycobacterium tuberculosis, on the other hand, is most often found in chronic cases and 25 percent of the time, the epididymis is engorged with a number of cysts and calcified deposits.
Sexually Transmitted Epididymitis
Multiple factors increase a man's risk of getting epididymitis caused by a sexually transmitted infection (STI), including:
High-risk sexual behaviors, such as multiple partners or having unprotected sex
- Previous history of an STI
Non-STI risk factors include:
Prior prostate or urinary-tract infections
- An uncircumcised penis
- Urinary tract abnormalities
- Recent urinary tract surgeries, catheterizations, or other procedures, which can introduce bacteria
- Enlarged prostate (benign prostate hyperplasia)
Depending on whether the condition is caused by a bacterial infection or sexually transmitted disease, symptoms can include:
Blood in semen (hematospermia)
- Sensitive, inflamed, red, or warm scrotum
- Testicular pain and tenderness that may get worse during a bowel movement
- Pain while urinating
- An urgent or frequent need to urinate
- Pain during intercourse or ejaculation
- Lump on the scrotum
- Lower abdominal pain or discomfort in the pelvic region
- Urethral discharge
To diagnose epididymitis, a physician first performs a physical exam and takes a patient's complete medical history. Red lumps or swelling in the testicles, as well as swollen lymph nodes in the groin, indicate the presence of an infection.
Other tests that can help confirm an infection:
Blood and urine tests (e.g., cytology test) that check for infection
- Sexually transmitted infection (STI) screening to test for bacteria and other microbes
- Ultrasound to rule out testicular torsion or tumors and to look for an enlarged, thickened epididymis
Epididymitis Treatment Options
Epididymitis treatments include antibiotics and anti-inflammatories which can be prescribed to reduce inflammation and fight off the infection. Surgery may be necessary in the event of necrosis, a scrotal abscess, or if the epididymitis is due to underlying defects (such as an enlarged prostate). Lifestyle changes and home care (such as cold packs or an athletic supporter) may also help alleviate symptoms.
Kavoussi, Parviz K.; Costabile, Raymond A. (2011). Disorders of scrotal contents: orchitis, epididimytis, testicular torsion, torsion of the appendages, and Fournier's gangrene. In Chapple, Christopher R.; Steers, William D. Practical urology: essential principles and practice. London: Springer-Verlag.
Epididymitis. (2010). Sexually transmitted diseases treatment guidelines. Centers for Disease Control and Prevention.
Granitisioti P. (2008). Scrotal pain conditions. In Baranowski, Andrew Paul; Abrams, Paul; Fall, Magnus. Urogenital pain in clinical practice. New York: Informa Healthcare USA.
Nickel JC. (2007). Inflammatory Conditions of the Male Genitourinary Tract: Prostatitis, and Related Conditions, Orchitis, Epididymitis. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 9